Empathy: A Practice not an Emotion

Young man on reception at psychologistEmpathy has been discussed as a basic component of effective nursing practice since the 1960s. It is important because empathy produces insight into an patient’s experience and coping with illness. These insights facilitate the nurse’s diagnostic accuracy, problem solving and care becomes more patient centered. When patients feel understood they become engaged in a helping relationship with the health care professional and are more likely to adhere to treatment recommendations and advice about healthy lifestyle changes (Wiseman 2007).

Concerns about expression of empathy in correctional settings

Correctional nurses sometimes express concern about being empathetic with inmates. A simple definition of empathy is that it involves the ability to see the world through another person’s eyes. In correctional practice this definition is sometimes misinterpreted to mean that you have to think, feel and act like a criminal or a murderer or a sex offender; an impossible and unethical expectation. Another misunderstanding about empathy in correctional nursing is that the nurse is letting their emotions or feelings guide their actions and they are at risk of being manipulated by the inmate. Empathy in nursing practice is not a subjective emotion or feeling but is instead a professional interaction (Dinkins 2011, Mercer & Reynolds 2002).

If empathy isn’t an emotion, what is it?

A more descriptive definition of empathy is that it is the ability to perceive and understand the meanings, feelings and concerns of another person and to communicate that understanding to the other person. Empathy involves perceiving, thinking and communicating about another person’s experience and concerns. You do not have to think or feel like the other person to practice nursing empathically. There are three parts to empathy in nursing practice, sometimes referred to as the Empathy Cycle, these are:

  1. Listening, reasoning and understanding. Essential skills are the ability to listen attentively and the sensitivity to perceive another person’s experience, concerns or perspective on a subject. Understanding is a cognitive process that involves reflection and the suspension of judgment.
  2. Conveying understanding of the other person and your intention to help. Communication must be patient centered, accurate; not judgmental or blaming.
  3. The patient’s awareness that the nurse has communicated understanding and believes it to be genuine and accurate (Mercer & Reynolds 2002, Wiseman 1996, Wiseman 2007).

An example of empathy in correctional nursing practice

Last week I observed a nurse in sick call. She was seeing a 19 year old man for complaints of headache and acne. During her assessment she checked his medication administration record and noted that he had missed several days of thyroid medication. At first she lectured him about the importance of taking it each day. He looked at his feet and mumbled his understanding and agreement. Next she asked why he wasn’t taking it and he replied that he was still bed when it was time for morning meds. They talked some more about why he couldn’t get up and the impact of not taking the medication. Finally she said “Staying in bed in the morning is more important to you right now, isn’t it?” He nodded yes. Her reply was “I understand; let me see if the doctor will change the medication time to noon or the evening. Would that work better for you?” He nodded and indicated verbally that it would help.

The nurse accurately understood that for this young man, the consequences of not taking the prescribed medication were so remote compared to his desire to stay in bed that he would forgo the medication even after having listened to the information she provided. She acknowledged his reality that staying in bed was more important to him and used the information to problem solve a way to increase his medication adherence.

At this same correctional facility where I observed the nurse conducting sick call, the correctional officers are taught in training academy to offer empathy in their interactions with inmates. The curriculum notes that empathy establishes a dynamic that allows the officer to assist the inmate in problem solving, to feel understood and supported. Empathy is described as the “crown jewel” of active listening technique. The fact that correctional officers are taught in training academy how to use empathy really seems to support correctional nurses’ use of empathy in their interactions with patients.

Empathy and the Standards of Professional Practice in Correctional Nursing

Several of the professional practice standards for correctional nurses published by the American Nurses Association describe empathy among the competencies that nurses must demonstrate to meet the standard. The nurse in the example given above demonstrated all of the competencies in her brief interaction with the patient during sick call. These include:

Standard 1 Assessment: The correctional nurse elicits the patient’s values, preferences, expressed needs, and knowledge of the healthcare situation to utilize such information as appropriate within the context of the correctional setting.

Standard 4 Planning: The correctional nurse develops an individualized plan in partnership with the patient considering the patient’s characteristics or situation, including but not limited to values, beliefs, spiritual and health practice preferences, choices, developmental level, coping style, culture and environment, safety of the patient, and available technology.

Standard 5 Implementation: The correctional nurse advocates for health care that is sensitive to the needs of the patient, with particular emphasis on the needs of diverse populations.

Standard 7 Ethics: The correctional nurse maintains a therapeutic and professional nurse-patient relationship within appropriate professional boundaries.

Standard 13 Collaboration: The correctional nurse promotes conflict management and patient engagement (2014).

Reasons for lack of empathy in nursing practice

The primary factor that has been identified as impacting the practice of empathy among health care professionals is a fixation on the tasks and technology of care coupled with time compression. Other reasons identified as impeding empathic practice include:

Difficult patients Anxiety about patients Feeling belittled or insignificant
Unsympathetic colleagues Lack of role models Fear of making a mistake
Individual nurse’s personality Intimidating environment Pressure on task completion

(Ward, Cody, Schaal, & Hojat 2012)

Every one of these factors could be present in the practice environment of a correctional nurse. How many of them factor into your practice environment and to what extent have they impacted your use of empathy in the delivery of patient care? Empathy is not solely a personality trait; it is a skill that can be taught and developed (Wiseman 2007). Taking a moment to reflect on our practice environment may identify opportunities to improve our empathic response in patient interactions. From there it is possible to create a plan of professional development in this area.

Empathy reminders for our practice

Helen Riess, Associate Professor of Psychiatry at Harvard Medical School gave her TEDx Talk audience (2013) the following mnemonic which she uses to help health care providers develop empathic responses in their patient care encounters.

E              Eye contact – this is first indication that we have acknowledged an individual and it begins the interaction

M            Muscles of facial expression – are the road map of human emotion, notice the patient’s facial expression

P             Posture – an open or closed posture indicates receptivity (or lack thereof) to interaction (both yours and the patients). Maintaining an open posture facilitates the patient’s interaction with the health care provider.

A             Affect – is a term for expressed emotion; try to identify label the patient’s emotion, and listen to the patient with that perspective, it will improve your understanding of what the patient is communicating

T              Tone of voice – is an indicator of emotion, vocal chords are located in the brain close to the same area that activates fight or flight response, changes in tone of voice may be an early indicator of emotion

H             Hearing the whole person – more than the words that are said, understand the context of the patient’s experience, and be non-judgmental in order to comprehend

Y             Your response – pay attention to your feelings; we respond to others all the time; know what you are conveying and manage your part of the relationship professionally.

Are the challenges of using empathy in your professional correctional nursing practice similar to those described here? If so what resources have you found helpful in addressing these challenges? Please reply by responding in the comments section of this post.

For more on the nurses professional practice relationship with patients in the correctional setting see Chapter 2 Ethical Principles for Correctional Nursing as well as Chapter 19 Professional Practice in the Essentials of Correctional Nursing. You can order a copy from Springer Publishing and get $15 off as well as free shipping by using this code – AF1209.

References

American Nurses Association. (2013). Correctional nursing scope and standards of practice. Silver Spring, MD: American Nurses Association.

Dinkins, C. (2011) Ethics: Beyond patient care: Practicing empathy in the workplace. The Online Journal of Issues in Nursing 16(2).

Mercer, S. W. & Reynolds, W.J. (2002) Empathy and quality of care. British Journal of General Practice Quality Supplement 52: S9-S13.

Riess, H. (2013) The power of empathy. TEDxMiddlebury. Accessed 4/25/2015 at https://www.youtube.com/watch?v=baHrcC8B4WM

Ward, J., Cody, J., Schaal, M., & Hojat, M. (2012) The empathy enigma: An empirical study of decline in empathy among undergraduate nursing students. Journal of Professional Nursing 28 (1) 34-40.

Wiseman, T. (1996) A concept analysis of empathy. Journal of Advanced Nursing 23: 1162-1167.

Wiseman, T. (2007) Toward a holistic conceptualization of empathy for nursing practice. Advances in Nursing Science 2(3): E61-E72.

Photo credit: © Africa Studio– Fotolia.com

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